FW-18-1486Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PER IT APPLICATIOINCANCR F
UILDING 0 ELECTRIC ROOFI -1 REVISION
❑PLUMBING ❑ MECHANICAL
Master fi
Sub Permit
❑ PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS: `C A/ W /00 S/1e..t�. l
City:
Miami Shores County:
Miami Dade
MAY 81n`�-12b
B�t"Y: �
SPBC2O1-4
EXTENSION 0 RENEWAL
❑ CANCELLATION
Folio/Parcel#: // 3//j / tji g Oyc o Is the Building Historically D
V
Occupancy Type: Load: Construction Type: k/v, G L. Flood Zone: BFE: & FFE:
OWNER: Name (Fee Simple Titleholder):..1)Au/ C ce AV4RR /A Phone#:
❑ SHOP
DRAWINGS
Address: `(Q /V lIL) 161
Q A i EIL
r
City: Z9$ JO
State. Zip: 3 !c0
Tenant/Lessee Name: Ph a#:
Email:
CONTRACTOR: Company Name:
Address: /� b 5„..} 24 `/_
City: �i�7 1/ /
Qualifier Name: S L 05,4
pave-
State:
3 zgq
lJ / U lJ Phone#: z z{ Z 7 7
State Certification or Registration #: (1 C` iJC'.OS-tO ( J
DESIGNER: Architect/Engineer:
Zip: 3 ?/
Phone#: 28, 2 22 2 7 70
Certificate of Competency #:
Phone#:
Address: ' " rCjy. State: Zip:
Value. of- Work ,for this Permit: $
Type of Work _ ❑ Addition
description of Work: (V�,,i• ;
J
/ZOO
1-1Alteration
b
,Squire
❑• � r. New
ear'Footage of Work: —f4-51
Rey air/Re Face p p ❑Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $
Structural Reviews $
CCF $ CO/CC $
DBPR $ Notary $
Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if;applicable)
Bonding Company's'Address
City a -5 State Zip `
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
'City »�..:_ tip State Zip
Application is hereby made to obtain a permit to do the work and installations as:indicated'I certify that no work or installation has
commencedprior to the issuance of apermit and that all work will be performed
performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER•y YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR •PAYING°;tWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a buildinginpiitrwith ri est aced alue exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement mu 'e posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absen • such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
/ 2 ) ,k_,, ^c—.
Signature( ,�
dWNER or AGENT
The"foregoing instrument was acknowledged before me this
2 t day of r fil.. , 20 / , by
1/o fdc), Gdaf6"l6Jerr t of _ who is personally known to
me or who has produced
identification and who did take an oath. er Pu
450.•••kt RMYAYNII}� #FF93
* MITARY PU
! EXPIRES: November 23,
NOTARY PUBLIC:
Sign:
Print:
Seal:
°for n.cfr Bonded Thru BudgetNOY Services
CONTRACTOR
ent was acknowledged before me this
20 I ,by
who is personally known to
oduced as
who did take an oath.
Sign:
Print:
Seal:
41-N RAYNIELFERNANDEZ
. * MY COMMISSION # FF 938686
EXPIRES: November 23, 2019
44tom it Bonded Thru Budget Notary Serves
****************************** ***** *** ******************************* ************** **n***********
5'3/ ei 5 3i
APPROVED BY PI Examiner/
Plans l Zoning
a
The forego
zv
instru
day of,
Structural Review Clerk
2
(Revised02/24/2014)